The URL can be used to link to this page

Home My WebLink AboutCHANGE ORDER - PURCHASE ORDER - 9122604CHANGE ORDER NUMBER C-1 5 PROJECT TITLE: Emergency Pipeline Repair Mobilization - Connell CONTRACTOR: Connell Resources, Inc P.O. NUMBER: 9122604 VENDOR NUMBER: 109445 CHARGE NUMBER: 5026415021 DESCRIPTION: 1. Reason for change: Substantial and Final Completion dates of the Contract have been exceede 2. Description of change: Extend Contract Times 3. Change in contract cost: No Change in Contract Cost 4. Change in contract time: Add 365 calendar days to Contract Times ORIGINAL CONTRACT COST TOTAL APPROVED CHANGE ORDERS TOTAL PENDING CHANGE ORDERS TOTAL THIS CHANGE ORDER TOTAL % OF ORIGINAL CONTRACT, THIS CO: TOTAL % OF ORIGINAL CONTRACT, ALL CO'S: ADJUSTED CONTRACT COST (Assuming all change orders approved) ACCEPTED BY REVIEWED BY: APPROVED BY: 1� Con ractor's Repr tive Dean dye, SpeciPhoctkmanager $100, 000.00 $0.00 $0.00 $0.00 0.0% 0.0% $100, 000.00 DATE: Z L3 DATE: l DATE Owen Randall, Chief Engineer ` APPROVED BY: DATE Jon Haukaas, Water Engineering and Field Services Operations Manager CC: Contractor Project File Purchasing Z NOTE: Signature of Contractor indicates agreement herewithin, including any adjustmei in contract sum or contract time. I:Eng/pmmanual/general/forms/change order form TRAVELERSJW RIDER License No. To be attached to and form part of Bond No. 105759943 Issued on behalf of Connell Resources, Inc. as Principal, and in favor of City of Fort Collins. 300 Laporte Ave., Fort Collins, CO 80522 as Obligee. It is agreed that: ❑ 1. The Surety hereby gives its consent to change the Name: from: to: ❑ 2. The Surety hereby gives its consent to change the Address: from: to: ❑X 3. The Surety hereby gives its consent to change the Contract time from: December 31, 2012 to: December 31, 2013 This rider shall become effective as of December 31, 2012 PROVIDED, however, that the liability of the Surety under the attached bond as changed by this rider shall not be cumulative. Signed, sealed and dated February 13, 2013 Accepted: City of Fort Collins Obligee IN S-4111 (8/66) Travelers Casualty and Surety Company of America Diane F. Clementson, Attorney -in -Fact - or Conpe4rftosources, Inc. P ncipal IS INVALID WITHOUT THE RED BORDER !� POWER OF ATTORNEY TRAVELERSJ Farmington Casualty Company St. Paul Mercury Insurance Company Fidelity and Guaranty Insurance Company Travelers Casualty and Surety Company Fidelity and Guaranty Insurance Underwriters, Inc. Travelers Casualty and Surety Company of America St. Paul Fire and Marine Insurance Company United States Fidelity and Guaranty Company St. Paul Guardian Insurance Company Attorney -In Fact No. 223049 Certificate No. 005252710 KNOW ALL MEN BY THESE PRESENTS: That Farmington Casualty Company, St. Paul Fire and Marine Insurance Company, St. Paul Guardian Insurance Company, St. Paul Mercury Insurance Company, Travelers Casualty and Surety Company, Travelers Casualty and Surety Company of America, and United States Fidelity and Guaranty Company are corporations duly organized under the laws of the State of Connecticut, that Fidelity and Guaranty Insurance Company is a corporation duly organized under the laws of the State of Iowa, and that Fidelity and Guaranty Insurance Underwriters, Inc., is a corporation duly organized under the laws of the State of Wisconsin (herein collectively called the "Companies"), and that the Companies do hereby make, constitute and appoint Darlene Krings, William C. Bensler, Kelly T. Urwiller, Diane F. Clementson, Anthony P. Stimac, Royal R. Lovell, Russell D. Lear, Katherine E. Dill, Brandi J. Tetley, K'Anne E. Vogel, and Jennifer Winter of the City of Greeley , State of Colorado , their true and lawful Atiomey(s)-in-Fact, each in their separate capacity if more than one is named above, to sign, execute, seal and acknowledge any and all bonds, recognizances, conditional undertakings and other writings obligatory in the nature thereof on behalf of the Companies in their business guaranteeing the fidelity of persons, guaranteeing the performance of contracts and executing or guaranteeing bonds and undertakings required or permittediin any actions or -proceedings allowed by law. IN day of WITNESSOCtObeEREOF, the Companies have caused this l tr �t b l�gned.aand t�� rrpoorate seals to be hereto affixed, this 31 St v_ Farmington Casualty Fidelity and Guaranty 4nsurancelCoinpany \"" Fidelity and Guaranty Insurance Underwrriters, Inc. St. Paul Fire and Marine Insurance Company St. Paul Guardian Insurance Company St. Paul Mercury Insurance Company Travelers Casualty and Surety Company Travelers Casualty and Surety Company of America United States Fidelity and Guaranty Company °NSUgY El0.F a APY..i NfG Y \NSUy JPIIY ANO �y •• w.(tt' J�..........a4 O Bc ,lF Fry Y� 'ttb ip O �°� G �•/M�.�� i s r•tOPVOR.I> �S PU:' Nl�� i Ci (.--•^�.AlWtm �! r:m w:c00.PRR F;. R�®: .y •977 79 �i 'n �! `o W CONN. Wlat. R u. 1898 7 u g o;SBAL.''r � e° � ,r� -_ y. F twuCt Ig.AN� fa ...... � 1 n� • • AIN State of Connecticut City of Hartford ss. BY P _' Robert L. Raney, Venior Vice President 31 st October 2012 On this the day of , before me personally appeared Robert L. Raney, who acknowledged -himself to be the Senior Vice President of Farmington Casualty Company, Fidelity and Guaranty Insurance Company, Fidelity and Guaranty Insurance Underwriters, Inc., St. Paul Fire and Marine Insurance Company, St. Paul Guardian Insurance Company, St. Paul Mercury Insurance Company, Travelers Casualty and Surety Company, Travelers Casualty and Surety Company of America, and United States Fidelity and Guaranty Company, and that he, as such, being authorized so to do, executed the foregoing instrument for the purposes therein contained by signing on behalf of the corporations by himself as a duly authorized officer. - p,TET In Witness Whereof, I hereunto set my hand and official seal. � My Commission expires the 30th day of June, 2016. Marie C. Tetreault, Notary Public 58440-8-12 Printed in U.S.A. This Power of Attorney is granted under and by the authority of the following resolutions adopted by the Boards of Directors of Farmington Casualty Company, Fidelity and Guaranty Insurance Company, Fidelity and Guaranty Insurance Underwriters, Inc.. St. Paul Fire and Marine Insurance Company, St. Paul Guardian Insurance Company, St. Paul Mercury Insurance Company, Travelers Casualty and Surety Company, Travelers Casualty and Surety Company of America, and United States Fidelity and Guaranty Company, which resolutions are now in full force and effect, reading as follows: RESOLVED, that the Chairman, the President, any Vice Chairman, any Executive Vice President, any Senior Vice President, any Vice President, any Second Vice President, the Treasurer, any Assistant Treasurer, the Corporate Secretary or any Assistant Secretary may appoint Attomeys-in-Fact and Agents to act for and on behalf of the Company and may give such appointee such authority as his or her certificate of authority may prescribe to sign with the Company's name and seal with the Company's seal bonds, recognizances, contracts of indemnity, and other writings obligatory in the nature of a bond, recognizance, or conditional undertaking, and any of said officers or the Board of Directors at any time may remove any such appointee and revoke the power given him or her; and it is FURTHER RESOLVED, that the Chairman, the President, any Vice Chairman, any Executive Vice President, any Senior Vice President or any Vice President may delegate all or any part of the foregoing authority to one or more officers or employees of this Company, provided that each such delegation is in writing and a copy thereof is filed in the office of the Secretary; and it is FURTHER RESOLVED, that any bond, recognizance, contract of indemnity, or writing obligatory in the nature of a bond, recognizance, or conditional undertaking shall be valid and binding upon the Company when (a) signed by the President, any Vice Chairman, any Executive Vice President, any Senior Vice President or any Vice President, any Second Vice President, the Treasurer, any Assistant Treasurer, the Corporate Secretary or any Assistant Secretary and duly attested and sealed with the Company's seal by a Secretary or Assistant Secretary; or (b) duly executed (under seal, if required) by one or more Attorneys -in -Fact and Agents pursuant to the power prescribed in his or her certificate or their certificates of authority or by one or more Company officers pursuant to a written delegation of authority; and it is FURTHER RESOLVED, that the signature of each of the following officers: President, any Executive Vice President, any Senior Vice President, any Vice President, any Assistant Vice President, any Secretary, any Assistant Secretary, and the seal of the Company may be affixed by facsimile to any Power of Attorney or to any certificate relating thereto appointing Resident Vice Presidents, Resident Assistant Secretaries or Attomeys-in-Fact for purposes only of executing and attesting bonds and undertakings and other writings obligatory in the nature thereof, and any such Power of Attorney or certificate bearing such facsimile signature or facsimile seal shall be valid and binding upon the Company and any such power so executed and certified by such facsimile signature and facsimile seal shall be valid and binding on the Company in the future with respect to any bond or understanding to which it is attached. I, Kevin E. Hughes, the undersigned, Assistant Secretary, of Farmington Casualty Company, Fidelity and Guaranty Insurance Company, Fidelity and Guaranty Insurance Underwriters, Inc., St. Paul Fire and Marine Insurance Company, St. Paul Guardian Insurance Company, St. Paul Mercury Insurance Company. Travelers Casualty and Surety Company, Travelers Casualty and Surety Company of America, and Uned•States Fidel y and Guaranty Company do hereby certify that the above and foregoing is a true and correct copy of the Power of Attorney executed by said Companiehichds in full force a\nd�'effect and has not been revoked. IN TESTIMONY WHEREOF. I have hereunto set my hand and affi ed the seals of" aid:Companies this 13th day of February , 20 13 TO-' Kevm F Hughes, Assistant Sect tary GI.SUA ` F10.f y ' ° �M..�M$ 9 J 1XSV s PJ ♦Fv AM ! V.R4WP0, � 'v/ t9e2 o ysr/ � z: ° NNiTPoRn, < t S!.95� �` SE AL.'o} '`• `O CONN. n i� OWL'L 7i 'uF 896 � To verify the authenticity of this Power of Attorney, call 1-800-421-3880 or contact us at www.travelersbond.com. Please refer to the Attorney -In -Fact number, the above -named individuals and the details of the bond to which the power is attached. Client#: 14427 CONREI ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE 2114/2013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Flood & Peterson Ins., Inc. P. O. Box 578 Greeley, CO 80632 970 356-0123 CONTACT NAME: Nikki MOsbrucker PHONE 970 266-7123 FAX 970 506-6823 A/C No Ezt : A/C, No E-MAIL ADDRESS: nikki.mosbrucker@floodandpeterson.com PRODUCER CUSTOMER ID#: INSURER(S) AFFORDING COVERAGE NAIC Of INSURED INSURER A: Travelers Insurance Company Connell Resources, Inc. 7785 Highland Meadows Parkway #100 Fort Collins, CO 80528 INSURER B : Pinnacol Assurance INSURER C INSURER D INSURER E: INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. MR L R TYPE OF INSURANCE R POLICY NUMBER MMIDD E/YYYY MMIDDFF POLICY ExP LIMITS A GENERAL LIABILITY X COMMERCIAL GENERALLIABILITY CLAIMS -MADE [ OCCUR I DTC04794N532- IND13 I 6/01/2012 06/01/201 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED PREMISES Ea occurrence s300,000 MED EXP (Any one person) $10,000 PERSONAL &ADV INJURY S1,000,000 GENERAL AGGREGATE $2,000,000 GENT AGGREGATE LIMIT APPLIES PER: POLICY X PRO- LOCI PRODUCTS - COMP/OP AGG $2,000,000 I$ A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS Drive Other Car I I DT8104794N532• TIL13 I 6/01/2012 06/01/20131 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 X BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ X X $ X $ A X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE DTSMCUP4794N- 532TIL13 6/01/2012 06/01/2013 EACH OCCURRENCE $10 000 000 AGGREGATE $10000 000 DEDUCTIBLE RETENTION $ $ X $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVEY/N OFFICERIMEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below /A 4029651 6/01/2012 06/01/2013 X We STATu- OTH- E.L. EACH ACCIDENT $500,000 E.L. DISEASE - EA EMPLOYEE $500,000 E.L. DISEASE- POLICY LIMIT I $500,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, It more apace is required) RE: CRI# 2121056 - Emergency Repair Mobilization Certificate holder is included as Additional Insured as required by written contract with respects to liability arising out of work performed by the named insured. City of Fort Collins PO Box 580 Fort Collins, CO 80522 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE (97988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) 1 of 1 The ACORD name and logo are registered marks of ACORD #S764757/M698847 KXH